John C. Staley

Malcolm, sieves are just fine as long as they keep the big important stuff in and let all the little trivial stuff out!  I like to tell people that my brain is full and if I learn anything new I have to forget something.  The problem is, I don't get to pick and choose what I forget.

Just a little food for thought.  Out here in Big Wonderful Wyoming if you are within 3 hours of a blood center it is something to not take lightly.  My suggestion, if the issue comes up for others would be to sit down with the blood center staff and find out how others do it.  They most likely work with folks even further away than you.  You really very seldom need to re-invent the square wheel.  I'm kinda lazy and I love to learn from the experience of others. 

Mabel, as I was walking home last night I was thinking about this and DIC did come to mind as something that is more frequent in OB bleeds than in most other massive transfusion events.  It might not be a bad idea to incorporate a DIC response into MTP specific to OB bleeds. 
 

Mabel, as I was walking home last night I was thinking about this and DIC did come to mind as something that is more frequent in OB bleeds than in most other massive transfusion events.  It might not be a bad idea to incorporate a DIC response into MTP specific to OB bleeds. 
 

Mabel, as I was walking home last night I was thinking about this and DIC did come to mind as something that is more frequent in OB bleeds than in most other massive transfusion events.  It might not be a bad idea to incorporate a DIC response into MTP specific to OB bleeds. 
 

Mabel, as I was walking home last night I was thinking about this and DIC did come to mind as something that is more frequent in OB bleeds than in most other massive transfusion events.  It might not be a bad idea to incorporate a DIC response into MTP specific to OB bleeds. 
 

There are probably some differences although they are probably case by case.  An amniotic embolism causes horrific DIC.  Trauma patients can also have DIC but maybe not so bad so quickly.  OB patients usually start with higher fibrinogen levels than other patients.  Obstetric hemorrhage can often be stopped once and for all by emergency hysterectomy whereas a massive trauma can't have everything fixed at once.  Sometimes in obstetrics you have to worry about both mom and baby.  Traumas can come in pairs too but not often with a newborn.  All those things seem like nuances that probably would not require much change to the protocol--except maybe making allowance for treating a newborn. 

I really like the question; "What are they doing with the results when you call?".  If they are not documenting and acting it's simple, quit calling after educating them on the proper use of computer available results.  Even if they are documenting and acting, educate and stop!  You are wasting your time and theirs.  I've said for years that I wish Alexander Graham Bell's parents had never met! 

Once again I'm forced to agree with David.  Keep it with the patient and complete the transfusion within 4 hours.  One question, did they disconect the unit from the IV set or just turn off the flow?  Not being familiar with the type of blood warming equipment in use at your facility I wonder about the process involved in stopping the blood, installing or attaching or what ever, the blood warmer and then restarting the blood flow.  I personally would not want to pull the spike from the unit and insert something else.  For some reason that would make me very uncomfortable.  Must be that paranoid blood banker lurking inside me! 

I'm pretty sure I have noted this before but it bears repeating.  Complicating a process does not improve it!  The simpler a process is the greater the chances are it will be followed especially if everyone is trained on WHY they are to do it this way.  
People have an interesting habit that when they don't know why they are required to do something a certain way they will find a "better" way to do it.  In short, if they don't know why they will not comply.

I'm pretty sure I have noted this before but it bears repeating.  Complicating a process does not improve it!  The simpler a process is the greater the chances are it will be followed especially if everyone is trained on WHY they are to do it this way.  
People have an interesting habit that when they don't know why they are required to do something a certain way they will find a "better" way to do it.  In short, if they don't know why they will not comply.

I'm pretty sure I have noted this before but it bears repeating.  Complicating a process does not improve it!  The simpler a process is the greater the chances are it will be followed especially if everyone is trained on WHY they are to do it this way.  
People have an interesting habit that when they don't know why they are required to do something a certain way they will find a "better" way to do it.  In short, if they don't know why they will not comply.

I'm pretty sure I have noted this before but it bears repeating.  Complicating a process does not improve it!  The simpler a process is the greater the chances are it will be followed especially if everyone is trained on WHY they are to do it this way.  
People have an interesting habit that when they don't know why they are required to do something a certain way they will find a "better" way to do it.  In short, if they don't know why they will not comply.

I'm pretty sure I have noted this before but it bears repeating.  Complicating a process does not improve it!  The simpler a process is the greater the chances are it will be followed especially if everyone is trained on WHY they are to do it this way.  
People have an interesting habit that when they don't know why they are required to do something a certain way they will find a "better" way to do it.  In short, if they don't know why they will not comply.

I'm pretty sure I have noted this before but it bears repeating.  Complicating a process does not improve it!  The simpler a process is the greater the chances are it will be followed especially if everyone is trained on WHY they are to do it this way.  
People have an interesting habit that when they don't know why they are required to do something a certain way they will find a "better" way to do it.  In short, if they don't know why they will not comply.

I really like the question; "What are they doing with the results when you call?".  If they are not documenting and acting it's simple, quit calling after educating them on the proper use of computer available results.  Even if they are documenting and acting, educate and stop!  You are wasting your time and theirs.  I've said for years that I wish Alexander Graham Bell's parents had never met! 

#3.
 
The fact that the question is being asked is the trick.

I have a question for you. What is your lab director's blood bank back ground? I had a lab director once and his only qualifications for the job was a BS in business (long story). He would ask these kinds of questions. 

I really like the question; "What are they doing with the results when you call?".  If they are not documenting and acting it's simple, quit calling after educating them on the proper use of computer available results.  Even if they are documenting and acting, educate and stop!  You are wasting your time and theirs.  I've said for years that I wish Alexander Graham Bell's parents had never met! 

The thing to keep in mind is that we do not order tests and we do not determine what is unnecessary.  You can take your concerns to your medical director or some committee but I have found over the years that unless it is something life threatening most medical directors I've worked with are unwilling to challenge another doctor's ordering practice so viewing such practices as job security is simply a coping mechanism that gets most of us through the day.  There, more philisophical drivel! 

The thing to keep in mind is that we do not order tests and we do not determine what is unnecessary.  You can take your concerns to your medical director or some committee but I have found over the years that unless it is something life threatening most medical directors I've worked with are unwilling to challenge another doctor's ordering practice so viewing such practices as job security is simply a coping mechanism that gets most of us through the day.  There, more philisophical drivel! 

Thanks for the responses.  I've discovered over the years that blood bankers love to live in the land of "What If".  You can be confident that I own a large home right in the middle of that land.    
 
I'm finding that patients are taking a more direct hand in their care and are much more knowledgeable than they were 30 years ago.  While info from a patient should be confirmed if possible, much more often than not they are reasonably correct if not complete in their info. 

My darling wife (the nurse) has 3 antibodies,  Her anti-K shows up at IS, goes away at 37o and returns at AHG.  It always has and I found it 30+ years ago.  Her anti-D shows up at 37 and at AHG.  Her anti-s showed up once, maybe twice, and then vanished never to be seen again.  She was a good one to give to students when trying to explain that antibodies have a nasty habit of not reading and following the book.
 
I've also seen a couple of anit-K "like antibodies" on regular blood donors who happened to work in the same area on the local Air Force base.  Neither had any history of transfusion or pregnancy (one male and one female).  The antibody was detectable for about 8 to 10 months then it went away and to the last of my knowledge never came back.  Chemical exposure?????
 
Gotta love the mysteries of biological systems.  I think that is what has kept me in the profession for so long. 

I won't be much help but keep in mind that no technology is 100% sensitive or 100% specific.  Your instrument will occasionally miss something.  I had a lot of problems from the corporate transfusion QA group when we first automated back in 1999.  They expected the instrument to be 100% and it simply was not.  Their expectations were far beyond the abilities of any technology.  I think it was the basic blood banker fear of change.  Luckily they got over it. 
 
It's always an excellent idea to check with other users for their experience and input.  I'm sure there will be a number of folks that can provide you with some real info and not just the philisophical drivel I provide. 
 
Good luck. 

Thanks for the responses.  I've discovered over the years that blood bankers love to live in the land of "What If".  You can be confident that I own a large home right in the middle of that land.    
 
I'm finding that patients are taking a more direct hand in their care and are much more knowledgeable than they were 30 years ago.  While info from a patient should be confirmed if possible, much more often than not they are reasonably correct if not complete in their info.